It’s true, they do. In last week’s New England Journal of Medicine, Andrew Bomback, MD tells us that the odors emanating from his patients aid in his diagnostic and therapeutic decisions. For instance, the smell of uremia makes kidney failure evident before the lab results return. Cigarette odors cause him to expand his differential diagnosis to include nicotine-related cancers.
Smells told him that a patient was dying, but also tell him whether a patient is getting better. “A patient who has showered and brushed his teeth before 6:30 a.m. is obviously getting ready to go home, no matter what his laboratory values might say.”
When I was practicing obstetrics, I could tell that a patient had ruptured membranes before my exam confirmed the diagnosis. (Healthy amniotic fluid has a fresh, light smell unlike anything else.)
We gynecologists actually have something we call the “whiff test” (I swear, it’s true!) By adding pottasium hydroxide to a bit of vaginal secretions, we can identify the telltale amines generated by certain bacteria that sometimes overgrow in the vagina, causing an infection we call bacterial vaginosis.
If we ever get telemedicine going, we will definitely need that “smell-a-vision” that our friend Emiril loves to talk about. (See? I told you I could turn any topic back into food….)
Category: Second Opinions
I recommend reading “The Cunning Man”, a novel by the late, great Canadian writer, Robertson Davies. It depicts an old-fashioed country doc who makes great use of his olfactory and other skills in diagnosis and treatment.
I just don’t want to think about it via odorama in telemedicine (too many memories of *Hairspray*, I fear).
When I was in the Peace Corps, I could pretty much diagnose Giardia on bus trips. Not an especially useful skill, alas.